Provider Demographics
NPI:1831138775
Name:CITY OF TEXAS CITY
Entity Type:Organization
Organization Name:CITY OF TEXAS CITY
Other - Org Name:CITY OF TEXAS CITY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILEY
Authorized Official - Suffix:II
Authorized Official - Credentials:CAPTAIN
Authorized Official - Phone:409-643-5705
Mailing Address - Street 1:1725 25TH STREET N
Mailing Address - Street 2:
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77590
Mailing Address - Country:US
Mailing Address - Phone:409-643-5705
Mailing Address - Fax:409-643-5719
Practice Address - Street 1:1725 25TH STREET N
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77590
Practice Address - Country:US
Practice Address - Phone:409-643-5705
Practice Address - Fax:409-643-5719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX300076207PE0004X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Multi-Specialty
No3416L0300XTransportation ServicesAmbulanceLand TransportGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1773814Medicaid
TX1773814Medicaid